Hospital, wheelchair

More than 90% of “high-touch” surfaces in long-term care facilities, including handrails and equipment controls, are contaminated with fecal matter and other potential sources of infectious disease spread, according to a study released Thursday.

Researchers used three different hygienic monitoring tools to evaluate the cleanliness of more than 30 surfaces in each of 11 long-term care facilities in South Carolina: adenosine triphosphate (ATP), a bioluminescent chemical reaction that indicates the presence of organic material; norovirus; and crAssphage, a recently discovered DNA bacteriophage that indicates past or present fecal contamination. The study was the first to utilize crAssphage as a fecal contamination indicator in the LTC setting, according to lead author Jennifer Cannon, Ph.D., of the National Foundation for the Centers for Disease Control and Prevention.

Findings suggested that 90% of the high-touch surfaces the researchers tested were positive for crAssphage or had organic material levels that resulted in failing ATP cleanliness scores. All 337 surfaces tested negative for norovirus, however, a finding that is consistent with previous studies suggesting noroviruses are rarely detected in the absence of a current or recent outbreak.

The researchers also found that surfaces touched by patients and visitors were twice as likely to have high levels of ATP compared to those touched primarily by nursing and janitorial staff or by patients alone.

The study’s results, published in the American Journal of Infection Control, provide new insights that could help LTC facilities recognize the need for greater assessments of the cleanliness of high-touch surfaces, thereby enhancing infection prevention and control measures designed to prevent serious diarrheal diseases and deaths among their residents, Cannon said. 

“Increasingly, hospitals are performing routine audits of high-touch surface cleanliness, helping to reduce morbidity and mortality among residents,” she said. “Our results suggest similar auditing programs would benefit LTC facilities when included as part of their infection prevention programs.”

Linda Dickey, RN, MPH, CIC, FAPIC, and current presidents of the Association for Professionals in Infection Control and Epidemiology, agreed, pointing specifically to the positive downstream effect on residents that these types of routine auditing programs can have.

“This study provides valuable new information that could help LTC facilities monitor their cleaning practices and refine their infection-prevention plans to better protect patients from serious diarrheal illnesses,” Dickey said.